Rudiger et al reported an extension of the Apgar score for newborn assessment.
Components:
(1) COMBINED score (expanded Apgar score)
(2) specified APGAR score (a modification of the conventional APGAR)
Determined at 1, 5, and 10 minutes after delivery.
Parameters for the COMBINED score:
(1) continuous positive airway pressure (C), CPAP
(2) oxygen (O)
(3) mask and bag ventilation (MB)
(4) intubation and ventilation (I)
(5) neonatal chest compression (N)
(6) exogenous surfactant (E)
(7) drugs (D)
|
Parameter |
Finding |
Points |
|
oxygen |
none |
1 |
|
|
given |
0 |
|
neonatal chest compression |
none |
1 |
|
|
given |
0 |
|
exogenous surfactant |
none |
1 |
|
|
given |
0 |
|
drugs |
none |
1 |
|
|
given |
0 |
If mask.bag or intubation/ventilation is 0, then CPAP is 0.
If intubation/ventilation is 0, then mask and bag is 0.
Else each is given 1 point if not given and 0 point if given.
|
CPAP |
Mask and Bag Ventilation |
Intubation and Ventilation |
Points |
|
not given (1) |
not given (1) |
not given (1) |
3 |
|
not given (1) |
not given (1) |
given (0) |
0 |
|
not given (1) |
given (0) |
not given (1) |
1 |
|
not given (1) |
given (0) |
given (0) |
0 |
|
given (0) |
not given (1) |
not given (1) |
2 |
|
given (0) |
not given (1) |
given (0) |
0 |
|
given (0) |
given (0) |
not given (1) |
1 |
|
given (0) |
given (0) |
given (0) |
0 |
COMBINED score =
= SUM(points for all 7 parameters)
total COMBINED-APGAR score =
= (COMBINED score) + (APGAR score)
Interpretation:
• minimum COMBINED score: 0
• maximum COMBINED score: 7
• minimum APGAR score: 0
• maximum APGAR score: 10
• minimum for both: 0
• maximum for both: 17
• A COMBINED-APGAR score < 10 indicates birth asphyxia (Table 4, Dalili et al).
Performance:
• A cutoff < 10 has a sensitivity of 0.97 and specificity of 0.99 for birth asphyxia.
• The area under the ROC curve was 0.99.
Specialty: Pedatrics
